Re: Bohdan I. Kudelya, 2025 CanLII 78507

Ontario Review Board

Re: Bohdan I. Kudelya

ORB File No: 6052

Hearing held on: Thursday, June 26, 2025

Place of hearing: Centre for Addiction and Mental Health (Via Zoom Video Conference)

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before: Alternate Chairperson: Mr. C. MacIntyre, KC Members: Dr. K. Hand Dr. G. Nexhipi Ms. C. Murray Ms. M. McKinnon

Parties Appearing:

Accused: Bohdan I. Kudelya Counsel: Mr. W. Jaksa

The person in charge of hospital: Counsel: Ms. M. Warner

Attorney General of Ontario: Counsel: Mr. M. Feindel

REASONS FOR DECISION

(Dated August 5, 2025)

Introduction

1On February 1, 2012, Bohdan Kudelya was found not criminally responsible on account of mental disorder on a charge of assault, contrary to the Criminal Code. Mr. Kudelya is currently subject to an Ontario Review Board Disposition of May 5, 2025, which detains him at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (CAMH) with privileges up to and including living in the community in accommodation approved by the person in charge and travel passes, including international travel, for up to three weeks with conditions.

2On May 14, 2025, the Review Board received correspondence from CAMH advising that Mr. Kudelya was admitted from the community to the hospital on an inpatient basis and was discharged on May 7, 2025. This time period of his removal from his community home prompted the hospital to advise the Board that Mr. Kudelya’s liberties were significantly restricted and CAMH requested a hearing to review this, pursuant to s. 672.81(2.1) of the Criminal Code.

3A date for Mr. Kudelya’s Restriction of Liberty hearing was struck for today, June 26, 2025 and the Review Board accordingly conducted a hearing virtually by way of Zoom audio visual technology to make a determination of whether Mr. Kudelya’s period of time in hospital between April 28 and May 7, 2025 constituted a significant restriction of his liberties and whether the same was warranted and appropriate.

4At the outset of the hearing the parties presented a joint position that Mr. Kudelya’s restriction of his liberties was necessary and appropriate and, while an inpatient, it represented the least onerous and least restrictive conditions for him. At the conclusion of the evidence the Review Board agreed with the parties’ joint position.

Background

5Mr. Kudelya is now 37 years of age. He was found not criminally responsible for assault on a neighbour in an adjacent apartment. He suffers from treatment resistant schizophrenia and substance use disorder in sustained remission in a controlled environment.

6Mr. Kudelya has had previous readmissions to hospital from the community for cannabis use in November 2016 and January 2019. A third prolonged stay in hospital took place between April 2019 and April 2020 due to his continuing use of cannabis, even in hospital.

7In December of 2022, Mr. Kudelya was discharged to a 24-hour supervised group home at 96 Dowling Avenue and he continued to live there at the time of his recent annual review in April of 2025. In July of 2022, he began working on a part-time basis for a few shifts weekly at the LCBO.

8Although Mr. Kudelya’s urine drug tests did not yield positive results for substances throughout the 2024 to 2025 reporting year, he was subject to transient breakthrough episodes of his psychosis. Mr. Kudelya feels better when his medications are reduced, however, this makes him vulnerable to these breakthrough symptoms. Mr. Kudelya and his mother often request a reduction in his medication.

9In September of 2024, Dr. McMaster in a consultation note, suggested that while Mr. Kudelya was in the high support setting of 96 Dowling, a slow titration of valproic acid combined with monitoring his mental state could take place. As a result, the nightly dose of valproic acid was reduced and it was ultimately discontinued in December 2024.

10Fortunately, with this change, Mr. Kudelya did not evidence breakthrough psychotic symptoms and he maintained his clinical stability. He remained on his nightly dose of clozapine, though Mr. Kudelya and his mother continued to request that these doses be reduced. The hospital recommended that any reductions should be managed while in the hospital setting, given his history of decompensation of his mental state when medication reductions were previously made.

Evidence at Hearing

11A Restriction of Liberty Hospital Report dated June 15, 2025, was filed as Exhibit 2 to this hearing. An excerpt from that report outlines the reason for his readmission to hospital on April 28 and the results of the efforts to reduce his clozapine medication. It is repeated as follows:

“The clinical team recommended that Mr. Kudelya pursue a reduction in the dose of the clozapine while hospitalized to prevent the risk arising from a possible mental state decompensation with a medication taper. To his credit, he agreed to attend the hospital’s emergency department on his own accord and remained admitted until his clinical team recommended a discharge back to the community.

Mr. Kudelya was admitted initially to the hospital’s emergency department and subsequently to CCC4. The admission occurred between April 28 to May 7, 2025. During the hospitalization, the dose of clozapine was reduced from 525mg to 400mg nightly.

With the medication dose reduction, Mr. Kudelya reported some improvement in the experience of self-reported “head pressure” symptoms. In this context, on May 2, 2025, he informed the CCC4 clinical team, “I feel liberated in my thought process… I feel able to think about my future and success.”

On May 6, 2025, Mr. Kudelya informed his forensic outpatient services (FOPS) team, “I feel pressure but it’s much less… less intense…” In exploring his cognitions during episodes of “head pressure”, he stated, “I feel if I think about a person, I may influence them in a negative way… they will feel bad…” At the time, he explained, “It (the thought) is irrational because it is not happening."

Of note, prior to the admission, Mr. Kudelya informed the FOPS team he was experiencing such irrational thoughts about influencing individuals in a negative manner when thinking about them and that the same was associated with experiences of “head pressure.” To help Mr. Kudelya cope with symptoms of anxiety associated with such thoughts, the FOPS team recommended treatment with fluvoxamine, an anti-depressant medication that treats anxiety and may also augment clozapine. Mr. Kudelya agreed, and the medication was initiated on April 14, 2025, at a dose of 25mg nightly for 7 days and increased to 50mg nightly thereafter. The medication was continued while Mr. Kudelya was in hospital and he endorsed that the same made him feel calmer.

Given Mr. Kudelya maintained clinical stability despite the reduction in the dose of clozapine and the ongoing overvalued cognitions during episodes of “head pressure,” the FOPS team recommended that he be discharged back to the community. He returned to high support housing at 96 Dowling on May 7, 2025.”

12Dr. Deep Jaiswal testified on behalf of the hospital at today’s hearing. He endorsed the information contained in Exhibit 2, confirming that the period in hospital from April 28 to May 7 was planned for the purpose of tapering down his clozapine and monitoring his mental status while doing so.

13At the conclusion of his hospitalization, no evidence of active psychosis was present although Mr. Kudelya still complained of episodes of “head pressure” accompanied by irrational thoughts. Dr. Jaiswal felt that these thoughts did not rise to the level of delusional thought but were rather “overvalued” thoughts.

14Dr. Jaiswal confirmed that Mr. Kudelya was willing to be readmitted to hospital and his only reluctance was due to a concern that the return to hospital might affect his housing. That anxiety reduced once he was reassured that his housing would not be affected.

15After his return to his residence Mr. Kudelya and his mother asked that the fluvoxamine be discontinued. This too was then tapered and ultimately discontinued, and he now continues only on the nightly reduced dose of clozapine.

Analysis and Decision

16Based on the evidence presented through Dr. Jaiswal and the Hospital Report of March 22, 2025, and the current ROL Report of June 15, 2025, the Board is entirely satisfied that the restriction of Mr. Kudelya’s liberties upon being admitted to hospital between April 28 and May 7, 2025 was significant, but that it was warranted and appropriate and his circumstances in hospital were the least onerous and restrictive. It would also be reasonable to consider that the period of restriction was a voluntary one as Mr. Kudelya had agreed to attend hospital for the purpose of reducing his medications dose. This was accomplished and his mental status satisfactorily monitored, and he was returned to the community on May 7, where he continues to reside.